X-ray computed tomography

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X-ray computed tomography

ICD-10-PCS ICD-9-CM MeSH OPS-301 code: MedlinePlus Intervention B?2 88.38 D014057 320...326 003330

X-ray computed tomography (x-ray CT) is a technology that uses computer-processed x-rays to produce tomographic images (virtual 'slices') of specific areas of the scanned object, allowing the user to see what is inside it without cutting it open. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of twodimensional radiographic images taken around a single axis of rotation.[1] Medical imaging is the most common application of x-ray CT. Its cross-sectional images are used for diagnostic and therapeutic purposes in various medical disciplines.[2] The rest of this article discusses medicalimaging x-ray CT; industrial applications of x-ray CT are discussed at industrial computed tomography scanning. Because x-ray CT is the most common form of CT in medicine and various other contexts, the term computed tomography alone (or CT) is often used to refer to x-ray CT, although other types exist (such as positron emission tomography [PET] and single-photon emission computed tomography [SPECT]). Older, less preferred terms that also refer to x-ray CT are computed axial tomography (CAT scan) and computer-assisted tomography. X-ray CT is a form of radiography, although the word "radiography" used alone usually refers, by wide convention, to non-tomographic radiography.

Sketch of a CT scanner.[3] CT produces a volume of data that can be manipulated in order to demonstrate various bodily structures based on their ability to block the x-ray beam. Although, historically, the images generated were in the axial or transverse plane, perpendicular to the long axis of the body, modern scanners allow this volume of data to be reformatted in various planes or even as volumetric (3D) representations of structures. Although most common in medicine, CT is also used in other fields, such as nondestructive materials testing. Another example is archaeological

uses such as imaging the contents of sarcophagi. Individuals responsible for performing CT exams are called radiologic technologists or radiographers[4] and are required to be licensed in most states of the USA.[5] Usage of CT has increased dramatically over the last two decades in many countries.[6] An estimated 72 million scans were performed in the United States in 2007.[7] One study estimated that as many as 0.4% of current cancers in the United States are due to CTs performed in the past and that this may increase to as high as 1.5 to 2% with 2007 rates of CT usage;[8] however, this estimate is disputed.[9] Kidney problems following intravenous contrast agents may also be a concern in some types of studies.

Contents

1 Diagnostic use o 1.1 Head o 1.2 Lungs o 1.3 Pulmonary angiogram o 1.4 Cardiac o 1.5 Abdominal and pelvic o 1.6 Extremities 2 Advantages 3 Adverse effects o 3.1 Cancer o 3.2 Contrast 4 Scan dose o 4.1 Radiation dose units o 4.2 Excess doses o 4.3 Campaigns 5 Prevalence 6 Process 7 Three-dimensional reconstruction o 7.1 Multiplanar reconstruction o 7.2 3D rendering techniques 8 Image quality o 8.1 Artifacts o 8.2 Dose vs. image quality 9 Industrial use 10 History o 10.1 Origins of tomography o 10.2 Mathematical theory o 10.3 Commercial scanners o 10.4 Etymology 11 Types of machines o 11.1 Previous studies 12 See also 13 References

14 External links

Diagnostic use
Picture of a CT scout (aka scanogram or topogram) as used for planning every scan slice. Since its introduction in the 1970s, CT has become an important tool in medical imaging to supplement x-rays and medical ultrasonography. It has more recently been used for preventive medicine or screening for disease, for example CT colonography for patients with a high risk of colon cancer, or full-motion heart scans for patients with high risk of heart disease. A number of institutions offer full-body scans for the general population although this practice goes against the advice and official position of many professional organizations in the field.[10]

Head
Main article: CT head

Computed tomography of human brain, from base of the skull to top. Taken with intravenous contrast medium.

Bone reconstructed in 3D CT scanning of the head is typically used to detect infarction, tumors, calcifications, haemorrhage and bone trauma. Of the above, hypodense (dark) structures can indicate edema and infarction, hyperdense (bright) structures indicate calcifications and haemorrhage and bone trauma can be seen as disjunction in bone windows. Tumors can be detected by the swelling and anatomical distortion they cause, or by surrounding edema. Ambulances equipped with small bore multi-sliced CT scanners respond to cases involving stroke or head trauma. Magnetic resonance imaging (MRI) of the head provides superior information as compared to CT scans when seeking information about headache to confirm a diagnosis of neoplasm, vascular disease, posterior cranial fossa lesions, cervicomedullary lesions, or intracranial pressure disorders.[11] It also does not carry the risks of exposing the patient to ionizing radiation.[11] CT scans may be used to diagnose headache when neuroimaging is indicated and MRI is not available, or in emergency settings when hemorrhage, stroke, or traumatic brain injury are suspected.[11]

Lungs
CT can be used for detecting both acute and chronic changes in the lung parenchyma, that is, the internals of the lungs. It is particularly relevant here because normal two-dimensional X-rays do not show such defects. A variety of techniques are used, depending on the suspected

abnormality. For evaluation of chronic interstitial processes (emphysema, fibrosis, and so forth), thin sections with high spatial frequency reconstructions are used; often scans are performed both in inspiration and expiration. This special technique is called high resolution CT. Therefore, it produces a sampling of the lung and not continuous images. An incidentally found nodule in the absence of symptoms (sometimes referred to as an incidentaloma) may raise concerns that it might represent a tumor, either benign or malignant.[12] Perhaps persuaded by fear, patients and doctors sometimes agree to an intensive schedule of CT scans, sometimes up to every three months and beyond the recommended guidelines, in an attempt to do surveillance on the nodules.[13] However, established guidelines advise that patients without a prior history of cancer and whose solid nodules have not grown over a two-year period are unlikely to have any malignant cancer.[13] For this reason, and because no research provides supporting evidence that intensive surveillance gives better outcomes, and because of risks associated with having CT scans, patients should not receive CT screening in excess of those recommended by established guidelines.[13]

Pulmonary angiogram

Example of a CTPA, demonstrating a saddle embolus (dark horizontal line) occluding the pulmonary arteries (bright white triangle) CT pulmonary angiogram (CTPA) is a medical diagnostic test used to diagnose pulmonary embolism (PE). It employs computed tomography and an iodine based contrast agent to obtain an image of the pulmonary arteries.

Cardiac
Main article: Cardiac CT With the advent of subsecond rotation combined with multi-slice CT (up to 320-slices), high resolution and high speed can be obtained at the same time, allowing excellent imaging of the coronary arteries (cardiac CT angiography).

Abdominal and pelvic

Main article: Abdominal and pelvic CT

CT Scan of 11 cm Wilms' tumor of right kidney in 13 month old patient. CT is a sensitive method for diagnosis of abdominal diseases. It is used frequently to determine stage of cancer and to follow progress. It is also a useful test to investigate acute abdominal pain.